a d m i ni s t er ing s acr e d n u r s in g ac t s
conduct ourselves during the process” of making a vow to another,
whether in marriage or otherwise.
This understanding of the dynamics of this need does not mean
sexual experiences, exploration, and experimentation do not and will
not occur separate from a meaningful relationship. It is part of learn-
ing about oneself and accepting the feelings one has at a very basic bio-
logical level. The challenge throughout life is to honor and celebrate
one’s sexuality and erotic feelings within the context of a safe, loving,
honoring, and intimate relationship.
Perhaps the biggest challenge with respect to our sexuality and
sexual needs is learning how to honor self and all of one’s being while
learning to accept vulnerability, allowing oneself to be vulnerable
with a trusted other, and cultivating a loving, respectful relationship
and union with a meaningful other.
However, a loving, safe, intimate context and experience may be dif-
ficult to find and sustain without personal growth and self-relationship
work. The ability to establish a loving, trusting, intimate sexual rela-
tionship is associated with early trusting relationships with parents. A
mature sexual relationship is one that allows for risk taking in the areas
of vulnerability and intimacy and Love itself.
Indeed, experiencing one’s sexuality and engaging in a mature sex-
ual relationship with another includes the ability to risk being hurt
and rejected—including not being loved or wanted in a sexual rela-
tionship—without being destroyed emotionally or psychically. It also
includes being able to give and receive, not engaging passively while
expecting another to be responsible for your needs and fulfillment.
Learning to recognize, acknowledge, and celebrate our sexuality
and sexual needs is part of the creativity of our life force and life itself.
It is part of learning to live within the body we have; to accept it, love
it, and appreciate it, with all its human frailties and conditions that
make us human. This life force is related to self-expression, creativity,
and the birthing of ideas and projects, helping connect us with honor-
ing and accepting our own bodies and physical demands as well as our
erotic and sensual needs.
Sexual expression is tied to pleasure and allows us to enjoy the
full experience of human contact and release. It can be both liberating
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and loving. When explored and experienced without shame, the raw
energy of eroticism can “elevate the human body and spirit into sen-
sations of ecstasy, even producing altered states of consciousness at
times” (Myss 1996:143). Thus, this basic human need is one to honor
and celebrate, not oppress or ignore. Assisting another with honoring
this basic need can be a healing act in itself, helping self and other to
dwell in all aspects of one’s human condition with high regard, respect,
and even awe. As such, it opens up avenues for deeper levels of trust,
relatedness, openness, and caring for both self and other.
signifiCanCe of tHe sexuality need for Caritas NursiNg
• The whole person is expressed through one’s sexuality; sexual-
ity is not separate from the whole person, personality, or self-
expression. It is important to honor its expression as well as
assess this need, along with other human needs, to help the per-
son be-in-right-relation with self and other.
• The sexuality need is interdependent on psychological-social
development as well as religious and sociocultural values, beliefs,
and practices.
• Sexual gratification and fulfillment are related to a man’s or a
woman’s confidence and pleasure in his or her self-concept and
masculinity or femininity.
• Sexual fulfillment culminates and grows throughout life as one
is able to enter into and sustain an intimate, loving relationship
with another person.
• The essence of one’s sexuality is evidenced in how one relates to
self and other; sexual need and sexual expression are interwoven
with one’s work, play, and life force.
• Conflicting and often extreme norms and myths about sex are
put forth in contemporary culture and the media. The two sex-
ual codes considered universal are (1) the expectation and right
that sexual relations will occur between marital/significant part-
ners and (2) the prohibition against incestuous relations between
parent and child and between siblings.
• Sexual behavior becomes a matter of concern for individuals or
groups when it violates or is in conflict with cherished social-
cultural expectations and values.
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Figure 17. Examen de Danse, by Edgar Hilaire Degas. Collection, The Denver Art
Museum.
• Society’s sexual myths and stereotypes, along with the complex
interaction of genes and the physiological-psychological and
environmental milieu, affect the internal and external forces that
comprise sexual identity, sexual expression, and so-called gender
differences between masculine and feminine, male and female.
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• Sexuality expression cannot be generalized from anatomical dif-
ferences between men and women; therefore, sexual need and
its unique expression are perhaps best understood as a gestalt of
the whole person.
• Sexuality and its expression are prominent at all stages of human
growth and development. The Caritas Nurse is often a key person
who can provide support, trust, understanding, information,
guidance, and assistance with conflicting feelings, problems, and
issues related to intimacy, birth control, pregnancy, parenthood,
and so on, including education and stereotypes related to health-
illness changes, age, and similar topics.
• The Philosophy and Science of Caring requires further study,
research, and specialization in this area to contribute to the evolv-
ing knowledge regarding assistance with this basic human need.
• In addition to the Carative Factor related to assisting with basic
needs generally, other Carative Factors/Caritas Processes related
to this specific need include number 4: developing and sustaining
an authentic helping-trusting-caring relationship; 6: using cre-
ative problem solving; and 7: individualized teaching-learning.
Human need for aCHievement:
exPressivity, Work, ContriButing Beyond self
Everyone has a longing at some level to engage in life with a sense of
efficacy, work, accomplishment, and expressive achievement that con-
tributes to the greater good, beyond self. This longing is a basic human
need, and one’s ability, capability, and opportunity to accomplish it
contribute to self-esteem and self-actualization. This need is associated
with an internal, self-defined standard of excellence that comes from
within rather than without. Thus, to assess this need one has to work
from the other’s frame of reference with respect to standards and defi-
nitions of excellence and achievement. What may be achievement for
one person may not hold for another. The outcomes of this expressiv-
ity and accomplishment are self-approval, self-acceptance, and a level
of competence and achievement that satisfies oneself. Of course, indi-
rectly, one’s achievements gain approval and recognition from others;
such interaction with others contributes to social graces, approval,
and acknowledgment from the outer world of one’s internal sense
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of satisfaction. However, if one’s goal is outer-world achievement at
the expense of what is internally meaningful, there is dissonance and
a sense of meaninglessness related to our outer-world accomplish-
ments. Without an inner motivation for self-expression, the achieve-
ment need becomes distorted or misdirected, leading to dissatisfac-
tion, dissonance, even despair, in that there is no inner anchor for
assessing the meaning if motivated solely by external forces. There
is an innate motivation for behavioral competence, directionality, and
purposeful striving in one’s life. The need is guided by realistic expec-
tations congruent with one’s talents, gifts, and skills as well as level of
maturation and readiness.
Gratification of this need is related to independent, inner-directed
accomplishments and self-appraisal of those accomplishments, as well
as others’ appraisal of the accomplishments. It has been acknowl-
edged in the psychological literature that biological drive alone does
not explain motivation and sense of achievement. It is a subjective,
psychologically complex situation related to meaning, personal inter-
ests, life experiences, self-concept, aesthetic qualities, play, explora-
tion, and approaches to problem solving; a complex interconnection
between and among cognitive-affective-behavioral experiences as well
as environmental situations.
Controversy regarding gender difference continues regarding
achievement and its manifestation in men and women, boys and girls.
Historically, especially in Western mind-sets, women were expected to
achieve in artistic pursuits, social-community interactions and roles,
and more private, domestic pursuits; men were more active in busi-
ness, sports, and outer-world accomplishments. In contemporary
society there have been major changes in social-cultural, modern, and
postmodern views of gender expectations. Thus, there is room for
freedom of movement without differentiated, stereotyped mind-sets
and expectations for achievements by men and women.
Views regarding achievement continue to acknowledge the com-
plexity of interaction among competence and inner expectations; tal-
ents, skills, and values; and access to opportunities. Together these
forces, combined with social norms and existing structures such as
family, church, school, community groups, and organized units of
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society, offer a necessary reinforcement value that is internally mean-
ingful to the individual. Rotter’s (1954) early classic Social Learning
Theory remains relevant. He posited:
Behavior potential is a function of Expectation plus Reinforcement Value
It can be framed as
BP = f (E + RV)
Within this view, there is an understanding that a person expects
that certain achievements will bring reinforcement he or she values,
which in turn will satisfy an internal standard of success or accom-
plishment. The self-approval needed from within and without may
change for a person who is ill or has an altered life situation. For exam-
ple, a man who has farmed all his life may be unable to perform the
degree of labor required for farming after a heart attack, surgery, and
so on. Thus, his expectations of former work and achievement goals
may be dramatically changed in ways that affect his self-approval, self-
esteem, and inner standards.
The practice of caring often involves helping others to (1) gain a
more realistic view of themselves and their expectations and (2) iden-
tify areas in which they can perform at a level they find satisfying. The
opportunity structure would therefore have to be considered, as would
shared social norms about expectation. Achievement is influenced by
the person’s expectations of success or failure in a given situation. If
past achievements are no longer realistic, the person has to experience
a repatterning of expectations as well as outcomes. Without a reap-
praisal and repatterning to create new expectations and new possibil-
ities, a sense of low self-esteem, helplessness, hopelessness, despair,
and depression can result. Compounding any personal life change in
one’s level of achievement are the sociocultural overlay and differ-
ent values and expectations among different cultures, socioeconomic
groups, geographic-climatic surroundings, and so on. Whether one is
exposed to and reinforced by values and expectations of achievement
or whether one is exposed to and reinforced by values and expectations
of failure will contribute to achievement behaviors. Different cultures
hold different values as to meanings of achievement. The Western
world increasingly defines success and achievement based on money,
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control, and power over others and their environment, whereas other
cultures and countries across time have valued and continue to value
higher-order states of civilization related to artistic, literary, cultural,
and spiritual accomplishments (art, music, poetry, sculpture, design,
architecture, evolved human potential, a moral community, a caring
society, peace, and similar values).
The achievement need is thus manifest at the individual and social-
cultural levels as well as reflected among the spiritual practices of an
individual, a people, a race, and a nation-state. These various dimen-
sions, values, views, and theories of achievement need to be consid-
ered in the practice of caring.
A Caritas Nurse is open to explore the variety of dynamics and
vicissitudes within this area as well as the potential evolution of his or
her views of achievement at the individual and civilization levels. Just
as self-worth and a sense of social approval are needed and desired
by humans at the individual level, the same notions can hold true for
nation-states and the different and meaningful forms of achievement
represented by different nations, cultures, and areas of the world.
Considering these matters at a higher order invites a higher level of
consciousness of individual and collective action and the way these
forms of action interact to affect the whole.
Within the ancient energy system, this need is related to the ener-
getic level of the “throat” and the “third eye.” It is within these energy
systems that one finds issues related to choice and personal expression
for using one’s power to create, to follow one’s dream, to pursue one’s
intellectual abilities, openness, ability to learn from experiences, and
so on (Myss 1996).
signifiCanCe of tHe aCHievement need for Caritas NursiNg
• To assist with this need, Caritas Nurses need to understand the
complex dynamics and forces operating behind the need and its dif-
ferent values, forms of expression at the individual and collective
levels, and how it manifests at the human and civilization levels.
• It is important for Caritas Nurses to be cognizant of and to
separate their own needs and values from what is important,
expected, valued, and realistic for the one-being-cared-for.
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• The Caritas Nurse works from the other’s point of view and sub-
jective human frame of reference, not exclusively from a medi-
cal, professional, clinical view of expectations.
• The practice of Caritas Nursing includes problem solving with
the other to help him or her find alternative ways to see the situ-
ation, meet expectations, and seek opportunities for personal
meaning, recognition, and satisfaction.
• The Caritas Nurse holds the person in his or her wholeness, even
when previous expectations and successes need to be altered; the
nurse never underestimates the person’s inner motivation and
potential for achievement.
• This need for achievement is affected by and affects all the other
basic needs in a complex, energetic, dynamic way, so the inter-
active nature of needs must be considered in an overall plan of
caring.
• The other Carative Factors/Caritas Processes operating with
this specific need include numbers 2: hope and faith; 3: nur-
turing individual spiritual practices/beliefs; 4: helping-trusting
caring relationship; 6: creative problem solving; and 7:
teaching-learning-coaching.
Human need for affiliation:
Belonging, family, soCial relations, Culture
The Deepest need . . . is [the] need to overcome . . . separateness
And leave the prison of aloneness.
eric fromm
Of all the basic human needs, the affiliation need comes closest to
revealing the core of our humanity and humanness. A basic assump-
tion is that people need people; this is a universal need and the basis for
thriving as a human. The function of this need is Belonging. The matu-
ration experiences are related to balancing dependence with indepen-
dence, privacy with intimacy, separateness with connectedness, and
individuation within the collective family of humanity.
Within the ancient energetic body system, this need can be located
energetically between belonging to the whole of humanity and devel-
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oping relationships, partnerships, and attachments to other people and
things, learning to honor one another in our interactions. It encom-
passes energetic dynamics related to humanitarianism, the ability to
engage in the larger pattern of life-humanity with values, ethics, and
courage.
Every human being has the need to be accepted and to belong to a
human group while also maintaining privacy and separateness. One’s
identity with group-belonging is closely related to establishing and
maintaining one’s own identity. One’s individual distinction comes
from the way a person conducts his or her own life in relation to other
people. A broad consideration of this need is centered in sharing, bal-
ancing individual and group dynamics and pressures, finding self in
other and vice versa, while honoring one’s unique self.
An earlier theory from social psychology and sociology, referred
to as the “Looking Glass Theory,” posited the position: “I look in the
mirror and I see myself as others see me.” This is a reminder that
Separation-Belonging: I-We, Me-Us constitutes a dialectical dynamic
that helps define the interactive process of achieving self-identity and
one’s relationship with self and other. Within this context it can be
explained that the affiliation need develops in response to environmen-
tal relatedness; one learns about oneself and others from the experi-
ences from one’s physical, social, behavioral, and emotional day-to-
day environment and relationships.
The affiliation system allows feedback from others; this is what
helps to shape one’s thoughts and to support feelings, what helps one
to identify and reduce anxiety. If one is deprived of this interaction,
the person may fail to develop his or her potential for relatedness
or become uncomfortable, withdrawn, or reclusive in interpersonal
relatedness.
Gratification and maturity with affiliation provide the capacity
for identification and commitment in social relatedness, allowing one
to be of use in one’s world. The underlying effectiveness of affilia-
tion is tied to consistent bonding, nurturing, and attachment between
mother/significant loving other and child from infancy onward.
Three interpersonal needs were identified in the early work of
Schultz (1967):
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1. Inclusion. The need for identity, attention, and association with
others; the need to belong; the struggle about whether one is
“in” or “out,” alone or together, private or public. Inclusion can
be associated with the original psychological notions of introver-
sion or extroversion in different characteristics of people.
2. Control. The need for autonomy; the power to influence author-
ity. Control also refers to decision-making processes between
people. The dynamic is between controlling others or being con-
trolled by others. It includes issues of dominance: top-bottom,
dependent-independent.
3. Affection. The need for intimate, emotional relationships
between and among others. These dynamics represent tension
between intimacy versus isolation, whether one is close to or dis-
tant from and with other humans. Affection includes feelings of
love, tenderness, acceptance, trust, warmth, and so forth; it also
represents the ability to constructively handle opposite feelings,
such as anger, hate, sadness, guilt, and related emotions.
These three interpersonal needs are manifest in the ancient
energetic systems described by Myss (1966). She points out that the
spiritual challenge of our energetic being is to learn to interact con-
sciously with others, to form unions with people who can support
our development and release relationships that handicap our growth.
Within the energetic model, Myss introduces the laws of magne-
tism within the context of relationships: “[T]hese laws mean that
we generate patterns of energy that attract people who are opposite
us in some way; who have something to teach us. Nothing is ran-
dom; prior to every relationship we have ever formed, we opened the
door with energy that we were generating. . . . The more conscious
we become, the more consciously we can utilize the energy” (Myss
1996:132).
Myss says that in every relationship there is a primary conflict of
faith and choice: relationships generate conflict and conflict gener-
ates choice. We break free when we learn to transcend the dualism
between others and ourselves (we are all connected at the human spirit
level) and transcend the dualism between God and ourselves. Myss
(1996:135) reminds us that as long as we focus on trying to control
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another person and forget that that person is a mirror reflecting back
to us our own qualities, we keep conflict alive. Seeing self and others
in “right-relation,” through symbolic connections for shared learning,
we learn to accommodate differences. This provides the foundation
for the deeper notion of communion, going beyond superficial affilia-
tion as a collection of interpersonal relationships.
Likewise, the energetic system involved with this need is related
to creative energy and the desire to contribute to the continuum of
life. This creative energy helps us break habitual patterns of relation-
ships, helping to reshape and repattern the chaos of our world and
our relationships (Myss 1996). Beyond our intimate personal relation-
ships, there is the affiliation with relationships outside the primary
family. These include extra-familial groups in the community (church,
school, peers, colleagues, neighbors, and business, social, and recre-
ational contacts).
These extra-familial relationships include (1) forming friendships
with others; and (2) sharing, associating, working, and joining with
others. These interactions lead to humanitarian service through com-
munity, civic, professional, religious, and charitable organizations.
They allow one to extend oneself beyond one’s immediate self. These
characteristics are related to altruism and caring for others, previous
and future generations. Without relationships, humans lose contact
with reality and the social nourishment necessary for survival. The
opposite of affiliation is isolation.
Reports across time and experiences highlight what happens to
people if they are isolated from other humans:
1. The “pain” of isolation: prisoners of war have reported that they
prefer torture to isolation from others.
2. People exhibit a strong tendency to dream, think, fantasize, and
occasionally hallucinate about others.
3. They experience withdrawal, suffering, apathy, diminished
growth and development, and even failure to thrive.
This basic need is affected by any health-illness situation. When
a person is worried about his or her health or is actually ill, the indi-
vidual often has decreased contact with others, including the family or
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primary support system as well as significant others. Decreased feel-
ings of belonging can result from such withdrawal or disengagement,
even though it may be a necessary coping process.
This gradual but real disengagement as a result of illness was cap-
tured in the previous section on the need for activity and the existential
story of van den Berg. The excerpt is relevant to understand how the
affiliation need is affected by even a minor illness and being in a “sick-
bed.” The sickbed, or form of isolation resulting from illness, leads
to loss of contact with day-to-day activities and routines, deprivation
and disruption of patterned behaviors and experiences we take for
granted. Suddenly, when life patterns are interrupted, there is a sur-
real sense involving even intimate relationships and familiar activities
that previously were commonplace; they become estranged and dis-
tant, even foreign, to the sick person.
Regardless of the life situation that triggers isolation from affilia-
tion (e.g., worry, illness, diagnosis, loss, change, fear, trauma, and so
on), when a person’s capacity to focus on others is reduced, his or
her usual affiliation needs change, resulting in frustration. At the same
time, when one’s affiliation is compromised, there tends to be a need
for a quantitative decrease of relationships—a desire for fewer peo-
ple around the person; one’s social space and social sphere contract.
Correspondingly, there is a qualitative increase in the value of the peo-
ple who are around the individual. Having fewer people around who
are special, close, intimate, and meaningful may be more satisfying
than having many people who may have only a superficial connection
to the person.
A hospitalized person may be denied the few qualitative relation-
ships he or she needs and desires and instead may have more limited
superficial relationships with a variety of often impersonal visitors or,
worse still, impersonal, detached caregivers: “They have swabbed me
clean of my loving associations” (Sylvia Plath).
Nurses are often the ones who affect the quality of interactions with
persons during illness; therefore, nurses and Caritas Nursing are vital in
assisting with the affiliation need. Such awareness and understanding
of this need at many levels are necessary to guide caring practices.
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signifiCanCe of tHe affiliation need for Caritas NursiNg
• The need for affiliation is a universal human need and it forms
the core of humanism.
• This need is the basis for one’s cooperative undertakings with
others in the world and the foundation for relating to self and
others.
• Affiliation behaviors are manifested differently by different peo-
ple on a continuum of privacy-separation of oneself to intimacy
and closeness with others. This is a learned process through
cooperative experiences, interactions, and participation.
• The primary group family best provides the relationship and
environment necessary for development of this need.
• The affiliation need and its manifestation are affected by health-
illness changes, hospitalization, and treatment regimes.
• During health-illness changes, a person has a reduced capacity
for others and a heightened need for quality relationships over
quantity of relationships.
• The Carative Factors/Caritas Processes that accompany this spe-
cific need most prominently are numbers 4: developing helping-
trusting-caring relationships and 6: creative problem solving.
Human need for self-aCtualization/sPiritual groWtH
Modern mainstream personality theories have acknowledged that
every human being has an internal striving to become, to grow, to
fulfill self. This striving is referred to commonly as the need for self-
actualization. It is considered a universal human need and is manifest
in unique ways.
As Siddhartha expressed it (Hesse 1951:31): “[W]hat was it they
could not teach you? And he thought: It was the Self, the character and
nature of which I wished to learn. . . . Truly nothing in the world has
occupied my thoughts as much as the Self . . . that I am one and am
separated and different from everybody else, that I am Siddhartha.”
This reference reflects the reality that every person in certain
respects is:
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1. Like all other persons (universal)
2. Like some other persons (group)
3. Like no other person (unique). (Kluckholn, Murray, and
Schneider 1953:53)
This focus points out the internal need for each person to mature
to the highest level of self as an innate striving. Values inherent to
self-actualization are related to inner meanings rather than to facts
alone. Perhaps it is more relevant to think of this need as an individ-
ual continuum along an inner self-defined movement; each individual
determines how far to seek fulfillment, with wide individual differ-
ences. These differences are related to a complex of past and present
experiences as well as successes along the way with other needs and
desires for self and one’s being-in-the-world. Some persons are more
achievement-oriented than others, which intersects with this need;
however, striving for self-actualization is closer to the birthing of the
inner spirit and its fuller, unique emergence.
While self-actualization is motivated internally, it is affected by
one’s external environment, often requiring a change externally to
repattern for more harmony of mind-body-spirit, Oneness-of-Being.
However, for one to “be-in-right-relation with self” may require
changes in relationships with others.
The concept of self-actualization in a conventional sense applies
to the mature adult. According to the work of Erikson (1963), the
self-actualized person is one who elevates his or her consciousness to
higher cultural, ethical, and spiritual levels. This conception includes
the notion of generativity—that is, an ecologically supportive environ-
ment for human caring and health for future generations as well as the
entire human species. Thus, a self-actualized person is concerned with
problems outside of and beyond self, with a mission in life for an inter-
nally oriented task to fulfill, a task that helps establish and guide the
next generation toward human and environmental health.
At the same time, it is idealistic and perhaps unrealistic for every-
one to evolve toward their highest level, in that we are all here on the
earth plane for our own experiences and purposes, and each person
has his or her own path to follow. However, this reality still allows the
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Caritas Consciousness Nurse to hold others in their highest ethical sense
of Being and Becoming, even if they cannot see it for themselves at
the moment. An awareness of this human need invites each of us,
whether nurse or patient, to listen and open to the inner call to follow
one’s authentic inner self in the outer world.
This need thus intersects energetically with evolving conscious-
ness and is consistent with Newman’s notion of “health as evolving
consciousness” (Newman 1994). Quality of living is associated with
self-love, self-awareness, and self-knowledge—allowing for more self-
caring, self-healing, self-knowledge, and self-control through insight-
ful, informed choices, decisions, and actions. This evolving awareness
provides one with the ability to face life more directly, with its pain,
joys, sorrows, and suffering as well as challenges, opportunities, and
successes. Our evolving consciousness contributes to our understand-
ing of life patterns and stresses and how they contribute to our well-
being or illness and disease.
signifiCanCe of tHe
self-aCtualization need for Caritas NursiNg
The notion of self-actualization placed within a contemporary ener-
getic Caritas framework invites other considerations that make new and
broader connections between the inner and outer in self-development
and between the human and the universe that go beyond the conven-
tional separatist mind-sets of the Western world—that is, the prevail-
ing mind-set that pits humans against each other, their environment,
planet Earth, and the larger universe that is our shared home. The
energetic mental field of consciousness is the entry point that “pours
endlessly into the human energy system, from the greater universe,
from God or the Tao” (Myss 1996:265).
By locating ourselves within the dominant view that separates
self from our spiritual-evolved consciousness dimension, except in pri-
vate personal matters, we find ourselves in a conflicted world of prac-
tice and human evolution. On the one hand, the world is filled with
spiritual awareness, from Florence Nightingale forward; on the other
hand, the public world favors exclusivity of the physical plane, lead-
ing to conflict, blame, and violence, wars against and over each other.
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Thus, we all are simultaneously caught in a worldview or cosmology
that continues to place sovereignty over external aspects of the mate-
rial and natural worlds, disconnecting us from our shared humanity in
the universe.
We need a larger cosmology to allow for both private and per-
sonal self-actualization and to connect with and open to the energy of
God consciousness, evolving consciousness, referred to as the spiritual
connector (Myss 1996).
Our recent history in an evolving Western culture allows for abun-
dant private and personal self-actualization efforts. We see, for exam-
ple, a multitude of spiritual practices in the areas of self-growth and
self-awareness pursuits, for example:
[E]thical service and humanitarian compassion, an inward turn
toward meditation, prayer, monastic withdrawal, spiritual pilgrim-
ages, involvement with great mystical traditions and practices from
Asia (Hindu, Buddhist, Taoist, Sufi), and diverse indigenous and
shamanic cultures (Native North American, Central and South
American, African, Australian, Polynesian, Old Europe). Recovery
of various Gnostic and esoteric perspectives and practices . . . devo-
tion to creative, artistic expression as a spiritual path, or renewed
engagement with revitalized forms of Jewish and Christian mysti-
cism, traditions, beliefs, and practices. (Tarnas 2006:31)
At the same time, these practices and personal pursuits for deep-
ening our humanity and the human evolutionary experience are “tak-
ing place in a cosmos whose basic parameters have been defined by the
determinedly non-spiritual epistemology and ontology of modern sci-
ence” (Tarnas 2006:31). In this dominant focus, these very rich, noble,
human spiritual pursuits are pursued in a universe whose nature it is
“to be supremely indifferent to these very quests” (Tarnas 2006:31).
This is a dilemma not only for the evolved human but also for
humanity and the cosmos. It is and has been one of the unnamed dilem-
mas of modern nursing. As Richard Tarnas (2006:31) put it: “The very
nature of the objective universe turns any spiritual faith and ideals into
courageous acts of subjectivity, constantly vulnerable to intellectual
negation” [original emphasis]. Put another way, both the contempo-
rary soul and our evolving consciousness pursuits of self-actualization
188
a d m i ni s t er ing s acr e d n u r s in g ac t s
(which are ultimately spiritual in nature) “live within us fully yet anti-
thetically. An impossible set of opposites thereby resides deep in the
modern sensibility” (Tarnas 2006:30) and within each of us.
Modern life is characterized by fundamental conflicts between reli-
gious worldviews that see humans as spiritual beings in a mean-
ingful cosmos and a scientistic worldview that sees physical matter
and physical energy as the only reality.
charles tart (quoted in vaughn 1995:29)
Thus, the human need for self-actualization, spiritual evolution,
spiritual fulfillment, evolving consciousness for transcendence, and
higher connections is complicated by an outer world that is material
and secular at its core. A new worldview or cosmos is upon us at this
point in human history. We are all on a journey toward an evolving
consciousness that is opening to an exploration of a vast spiritual uni-
verse of many paths that lead to wholeness, from fear to love and from
material bondage to wisdom and inner freedom (Vaughn 1995).
This awakening from the Heart center, energetically moving
upward in the body system, is the path of a Caritas Nurse and Caritas
Nursing; this path integrates the shadow and light sides of our deep
humanity, the joy and suffering side by side, not denying any part of
the human experience to which we all belong. We as a civilization at
this point in human history must awaken to a new cosmology and
worldview that can be referred to as a Universal Heart—a universe
that is a spirit-filled energy consciousness to which we all belong and
have our being; a universe that is interdependent, connecting every-
thing and us; a universe alive and evolving in harmony with each of us
on the path of awakening. So, to repeat: what we hold in our hearts
matters and affects our own evolution and that of humanity itself.
As developed in more depth in Caring Science as Sacred Science
(Watson 2005), a model of Caring Science creates open heart space to
connect the ethic and infinity of Cosmic Love, allowing for the inner and
infinite nature of our reality to emerge and be present with respect to
our Being and Belonging to the wider universe. In this work and world
of Caring Science and Caritas Nursing, we are not restricted to the outer,
189
a dmi ni st ering sacr e d nu rs i ng a ct s
Figure 18. Soaring, by Andrew Wyeth. Collection, Shelburne Museum, Shelburne,
Vermont.
physical world alone; that was the science model of a past era, which cut
our humanity off from its life source and cut the heart and soul out of
our personal and professional lives and work (Watson 2005).
As we examine the truth of Belonging-Being-Knowing and Doing
our caring-healing work in the world, how can we any longer bear
to sustain and perpetuate an empty, hollow model? Especially once
we honor and acknowledge our participation with the infinity and
the mystery of healing and life itself? This evolving model of Caring
Science opens science and our knowing to its Source—not its separa-
tion—from the knowable and unknowable to a wisdom that knows
and honors/surrenders to the differences. (Watson 2005:67)
Now we reenter a new space in which there is once again room for
miracles in our life and work and world. This era in Caring Science is
a time for reenchantment of the wonders, the unknowns, the myster-
ies of the universe, awakening the heart as well as the wisdom-seeking
mind, beyond knowledge itself. Such an opening in our worldview
takes us to the last Carative Factor/Caritas Process.
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c h a p t e r f i f t e e n
From Carative FaCtor 10: Allowance for
Existential-Phenomenological Forces
to Caritas ProCess 10: Opening and
Attending to Spiritual/Mysterious and Existential
Unknowns of Life-Death*
As for me, I believe in nothing but miracles.
Walt Whitman
This factor in the original (1979) work is perhaps the most difficult one
for people to grasp, in part because of the language and terms. All I
am trying to say is that our rational minds and modern science do not
have all the answers to life and death and all the human conditions we
face; thus, we have to be open to unknowns we cannot control, even
allowing for what we may consider a “miracle” to enter our life and
work. This process also acknowledges that the subjective world of the
inner-life experiences of self and other is ultimately a phenomenon,
an ineffable mystery, affected by many, many factors that can never be
fully explained.
* Phrase “allowing for a miracle” courtesy of Resurrection Health, Chicago.
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fr om carative fa c to r 10 t o C ar it as ProC e s s 10
We live in a world in which we can invite new views of science,
art, spirituality, and the mystery of life back into our world. A Caring
Science framework acknowledges that we ultimately dwell in mystery;
life is not a problem to be solved but a mystery to be lived; human
problems reside in ambiguity, paradox, and impermanence; suffering,
healing, miraculous cures, synchronicity are all part of the dynamic
of vibrating possibilities in our evolved consciousness. Thus, within
the Caritas Consciousness Model of Nursing, the nurse is open to what
Resurrection Health called “allowing for a miracle,” whereby the
Caritas Nurse holds the patient’s hope for a miracle. The Caritas Nurse
is open to other happenings at a higher order even in the midst of
modern science and concrete treatment; thus, he or she is always open
to the mystery of a deeper order of the universe unfolding within a
bigger picture than the human mind.
This Carative Factor/Caritas Process honors the reality that when
anyone has a major life change, the person returns home evoking at
a deep level an existential-spiritual crisis. A sudden life change as a
result of a new diagnosis, illness, trauma, or abrupt life-death circum-
stance requires a total reexamination of one’s life: questions arise as
to what is most important. What are one’s priorities? What matters
when one has to stop midstep in the midst of one’s usual life? These
questions are existential-spiritual in nature and are responded to based
on the experiencing person’s phenomenological life view. Everyone
responds differently depending on their experiences, values, belief sys-
tem, perceptions, the meaning of the condition, situation, support sys-
tems, courage, determination, and so on—all of which give them the
strength to face life and its vicissitudes of change and impermanence.
The personal struggles and inner crises of experiencing suffering
and turmoil in one’s life and health do not fit into any categories of
modern medical science; they are existential and unknown in nature,
unique to that individual and his or her life circumstances. It is Caring
Science, not medical science, that can offer another way to view human-
ity and the human condition of Being-in-the-world; to look at and into
the inner-life world through the other person’s eyes, not through a
medical science lens. For it is only through a broader, more existen-
tial-spiritual lens that we can surrender to the mysteries of human life
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f r o m ca ra t i v e f a c to r 10 t o C a r i t a s P r o C e s s 1 0
and human predicaments. Many people have experienced tragedies
in living and dying; often, these instances bring profound depth and
meaning to one’s life rather than the shallowness and superficiality of
a diminished level of living in the material plane alone.
Such profundity of living is shown in the existential-spiritual
struggles of Viktor Frankl (Frankl 1963). As a prisoner in a concentra-
tion camp for a long period of time, he struggled to find a reason to
live after his release. His entire family, except for his sister, had died
in the camps. He lost every possession, had every value attacked, had
suffered from hunger, cold, brutality, and fear of extermination. Yet
he was able to find a deeper meaning and responsibility in his life that
transcended his sorrows and suffering.
In contrast to Frankl’s involuntary suffering and his search for
deeper meaning is the example of Leo Tolstoy. He had an aristocratic
life of luxury and wealth but voluntarily subjected himself to suffer-
ing, deprivation, and isolation to find meaning and responsibility in his
life. Although Tolstoy’s philosophy was not considered existential at
the time in that it was more a spiritual quest, the beliefs he held in the
early 1800s are closely related to the later existential views of Sartre
(1956), Heidegger (1962), Buber (1958), and others. Thus, we see the
overlap between and among existential and spiritual questioning and
quests in the human search for meaning.
These notions of existentialism, phenomenology, and spirituality
are closely related and support a subjective appreciation of the inner-
life world of the experiencing person, as well as an appreciation for
the mysteries, multiple meanings, and unknowns of life. This Caritas
Process invites an opening to allowance for mysteries, miracles, and a
higher, deeper order of life’s phenomena that cannot be understood
with the ordinary mind and mind-set. In other words, the outer appear-
ance or behavior of what is happening to another in the outer world
may not necessarily reflect the inner subjective unknowns or deeper
dimensions of the larger universe. Acknowledging and incorporat-
ing this Caritas Process into nurses’ understanding of practice can be a
guiding influence and a turning point for healing, whereby a tragedy
can turn into a miracle of courage and strength, opening to another
reality of life’s deep meaning.
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fr om carative fa c to r 10 t o C ar it as ProC e s s 10
the evolved Caritas Nurse
Once we incorporate evolving consciousness awareness into our frame
of reference, including the interconnectedness of the ancient ener-
getic body system, we open to the wider universe in awe and wonder.
As nurses and the human community move energetically into heart
space, we move closer and closer to our spiritual nature and to con-
necting with the infinite source of universal Love. As we progress and
evolve toward this deeper awareness, we come closer to honoring the
sacred, the higher spirit of the universe, as an integral part of our lives.
We use these deeper connections to guide us.
We open our hearts and minds to seek a deeper, more intimate
relationship with that which is greater than self, the Divine. We open to
prayer, to humility, to asking for what we need from the larger universe
through acts of faith and hope. We once again open to the transcendent
dimension of living and dying, beyond the physical body localized in
the material plane alone. This Caritas Process awakens us energetically to
seek devotion, inspirational words, affirmations, prophetic beliefs, mys-
tical and miraculous connections and ideas. It is aligned most directly
with the highest energy source of cosmic Love, which honors a spiritual
awakening, moving us beyond the group mind to connect consciously
and intentionally with that which is greater—God, the Divine—allowing
for miracles as well as mystical transcendent experiences; overcoming
loneliness, isolation, even madness when faced with that which is con-
sidered unbearable. Through this Caritas Process and grasping its mean-
ing we learn how to understand that the human learns how to bear the
unbearable through this awakening connection. The result not only can
be transformative in moving through the dark night of the soul, but
also it can lead to profound insights, depths of gratitude, and apprecia-
tion of all one is learning through the journey of life itself: the joy, pain,
and everything. One can also experience profound bliss, blessings, and
inner peace once one is capable of surrendering to these deeper connec-
tions in the midst of darkness, fear, and despair. It is in this space that
miracles can and do occur and people report experiences with angels
and other happenings beyond the ordinary realm of existence.
In summary, nursing as a profession daily confronts special circum-
stances and people’s struggles with their own Being and the meaning
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f r o m ca ra t i v e f a c to r 10 t o C a r i t a s P r o C e s s 1 0
of the human predicaments of life and death, the challenges and reali-
ties of life-death crises of existence in between ordinary life passages.
Everyone has a personal story about his or her experiences and pre-
dicaments. Each person seeks his or her own meanings to find inner
peace and right-relation in the midst of fear, hatred, threats, doubts,
despair, and unknowns.
These situations and experiences that face the nurse invite the
nurse-self to confront her or his own state of meaning, of Being and
Non-Being. When a person is able to explore her or his own existence
and evolving consciousness for maturity in engaging in the vicissitudes
of life and death, the individual’s heart is opened to more compassion,
awe, dignity, and respect for unknowns; we become more mature,
more real, and more authentic to self and others in our personal and
professional life. We open to previously unrecognized sources for
hope, courage, power, and miraculous happenings in our life as well
as in the lives of others.
Consideration of and openness to this dimension of nursing may
be the most fulfilling aspect of practice. Explanatory notions of this
aspect of nursing not only are best understood from an existential-
spiritual-phenomenological lens but perhaps are only understood
from this higher plane of seeing the world.
CoNClUsioNs
the Caritas Nurse/Caritas Nursing
This model of nursing is not for every nurse. It is an invitation
to nurses who seek a deeper dimension of their work and calling in
their caring and healing practices. In recent years there have been
calls for nursing to renew itself. One aspect of such renewal comes
from renewal of the spirit. The last Carative Factor/Caritas Process
addresses this renewal of the spirit of self and system by attending
to this awareness, this awakening. This revised book, The Philosophy
and Science of Caring, goes beyond models of health-illness and dis-
ease. It aligns nursing and its authentic mission of health-healing with
a deeper humanitarian and spiritual cause; that cause is about helping
to sustain humanity itself, contributing to the evolution of human-
kind toward more spirit-filled beings connected with the infinite field
195
Figure 19. Holy Trinity, by Hildegard of Bingen. From Illuminations of Hildegard
of Bingen, © Otto Müller Verlag, Salzburg, 1954.
f r o m ca ra t i v e f a c to r 10 t o C a r i t a s P r o C e s s 1 0
of universal Love (Watson 2005). This work is ultimately about trans-
lating a deep ethic, an authentic value system, along with theory and
knowledge, into living and breathing models of caring and healing in
the world and in our daily work.
Thus, in positing nursing within this evolved work and world of
healing, we are contributing to the healing of self and others, evolv-
ing toward a moral community; this evolution aligns human caring
and healing with peace. We do not do this by some grand scheme “out
there” or in a theory textbook, in some distant fantasy model. We live
it in our daily practice, our moment-to-moment encounters with self
and other. We do it through a disciplined approach to our personal
practice, which in turn becomes a more mature professional model
accessing the energetic connections of human-universe as part of our
evolution.
In this Caritas Model of Nursing as the Philosophy and Science of
Caring, we can identify at least two types of service to humanity:
1. Overt service—the outer world of clinical practice at the body-
physical, material-technological level of medical services, tasks,
procedures, and so on. This level of so-called ordinary or regular
nursing would work from a consciousness that focuses more on
the base energetic, physical body system with an unreflective
ego mind-set.
2. Subtle service—the inner world of practice at the heart level,
evolving toward a higher consciousness that cultivates an awak-
ening of the heart and mind, embracing the finest of the medi-
calized, technical outer world while consciously cultivating the
subtle inner practices of evolving our own humanity. We learn
that we are Being and Becoming the Caritas-Communitas field,
informing practices in our daily life that contribute to a collec-
tively evolving spiritual Caritas Consciousness. As nurses individu-
ally and collectively engage in Caritas Consciousness, they become
the magnetic field of attraction for others, offering a new field
of compassion and a calming, soothing, loving presence in the
midst of life threats and despair.
This view of “Being the Caritas Field” for caring and healing, which
embraces both overt and subtle practices, is transformative for self and
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fr om carative fa c to r 10 t o C ar it as ProC e s s 10
other. This is the noble work for humanity itself within an ancient
and noble profession; it aligns nursing with its true mission of sustain-
ing humanity from within and without the medical system. This new
evolved form of nursing can be considered Caritas Nursing, Energy
Nursing, Transpersonal Nursing, Holistic Nursing, Contemplative
Nursing, and so on. Whatever it is named, it goes beyond ordinary
nursing and sets a new and higher standard of excellence for caring,
healing, and peace in the world.
Lee Kaiser, a health futurist and visionary, has said that “nurses of
the future will be hired because of their caring consciousness” (Kaiser
personal communication, 1989). The level of development of Caritas
Nursing described in this book gives new meaning to his projections.
Whatever this evolved nurse/nursing is called, it offers a hopeful
paradigm and vision for humanity, for health, for humans and all liv-
ing things, for a living planet and universe in which we are co-creating
our own destiny and future. This is the ultimate future for nurses’ full
contribution to society. As nursing enters this new, deep transforma-
tive field of Caritas practices, we each enter an entirely different new
world for the new millennium unfolding before us.
This Caritas Consciousness evolution also requires a new language:
an alchemical, transformative, nonmedical, nonclinical language.
Caring/Love/Caritas is not sentimental but taps into our connection
with the infinite field of healing Love. It is not that we dismiss the
overt outer world and its empirical, clinical, technical language; it is
that we realize that the two different language systems vibrate at a dif-
ferent level. We are at a point in our human and disciplinary maturity
that we can admit and embrace new languages of beauty, poise, grace,
charm, mercy, miracles, mystery, and so on. We need language and
discourses that vibrate at a higher frequency, that stretch us into new
depths of meaning, new evocative understandings, metaphors, myths,
stories, and wise images that conventional, outer technical worlds and
words cannot convey but that are needed to touch the deeply human
dimensions of our world.
The word “Nurse” may be one such word with paradoxical vibra-
tions. It operates in both the overt and subtle energetic worlds and
words. It is more established and developed in the overt material model
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f r o m ca ra t i v e f a c to r 10 t o C a r i t a s P r o C e s s 1 0
of outer basic energetic work; it has yet to cultivate the language and
actions that reflect the next evolution and mature Caritas Nursing,
which reflects the subtle energetic field of Caritas. Yet this subtle evo-
lutionary practice of nursing may be the hope for nursing’s authentic
survival; this level of nursing is a very different quality of nursing from
that commonly known in the twentieth century. The evolved Caritas
Nurse turns to “things of spirit” as well as material form.
When nursing individually and collectively engages in caring and
healing practices at this higher-deeper, subtle but powerful vibratory
level, we will turn to words and actions that vibrate at a higher level—
words and actions that nurture Spirit and the human soul of our work.
We turn to, for example:
Beauty
Silence
Nature—other living things
Arts
Music-Sound
Relationships
Personal Story—literature-drama-film-narratives
Movement-Dance
Prayer
Meditation
Mystery—metaphors
Miracles
Infinity of Universal Love—opening to Miracles
Grace and Mercy of life and all its gifts
God
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P a r t I V
Expanding Knowledge-Building Frameworks for Reconsidering
Caritas Nursing: The Energetic Chakra-Quadrant Model
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c h a P t E r s I x t E E n
Integral Model for Grasping Needs in Caritas Nursing
The Church says: The body is a sin.
Science says: The body is a machine.
Advertising says: The body is a business.
The body says: I am a fiesta.
Eduardo GalEano, Walking Words (quotEd In arrIEn 2005:77)
As discussed in previous work (Watson 2005), Wilber’s Integral Model
(Wilber 1998, 2001a, 2001b) provides a Caring Science/Caritas con-
text for grasping the totality of a broader disciplinary focus for pro-
viding views of the body and thus basic nursing care. In Wilber’s
Four-Quadrant Integral Model we move toward greater depth to com-
prehend multiple ways of Knowing and Being and Becoming—an
approach that integrates and includes subtle and dense matter, body,
soul, and Spirit (Wilber 1998:102). This model seeks to point toward
203
I nt EG ral M odEl f o r G ra s P I nG nE E d s In C ar it a s n u r s i n g
Table 16.1 Wilber’s Four-Quadrant Model (from Wilber 1998)
Interior: Upper left Exterior: Upper right
Subjective meaning–inner-life world; Objective-external physical world
phenomenological view; incorporates Outer-world information, measurement
spirit realm Judgments of observations
“I” Knowledge/Knowing “It” Knowledge/Knowing
Location of intentionality, interpretive Location of behavioral, she/he biological
consciousness, and often unmeasurable observable realm
realm of invisible inner states of mind,
thoughts, consciousness
Interior/Intersubjective/Collective: Lower left Interobjective/Exterior Collective: Lower right
Collective meaning; social, cultural norms Social-community outer-world views
“We” Knowledge/Knowing “It”–“They” Knowledge/Knowing
“Our” (tribal-group) perspective, interior Visible norms, communal, environment,
We/Our; invisible web of worldviews, social systems
morals, religion, spiritual beliefs, myths, Collective behaviors of group, family (pro-
archetypes, magic realm fessions), village, nation-state, planetary
Symbolic meanings, historic influences,
metaphoric associations
integration of the immanent with the transcendent-transpersonal, the
sacred with the ordinary (Watson 2005).
The four-quadrant model offers a framework for most basic views
of subjective/objective, individual/collective, insider/outsider tem-
plates for understanding core components of a given process, phe-
nomenon, or practice at a given point in time.
Within Wilber’s integral framework, he acknowledges that we
need knowledge and practices in all four quadrants. However, within
the practice arena, nursing has historically tended to locate itself profes-
sionally with the right side of the quadrant, while within the academic
world, some of the most rapidly evolving disciplinary-theoretical work
tends to lean toward the left side of the quadrant.
In reality, we need the integral, comprehensive approach for Caring
Science and notions of Caritas practitioners. This broader framework
acknowledges and systematically allows for all ways of knowing as
well as for evolving ways of knowing yet to be named and explored
(Jarrin 2006), allowing for different levels of development, different
levels of consciousness evolution, different intelligences—moral and
204
Int EG ral M o d E l for G r as P I nG nE E ds I n C a r i t a s n u r s i n g
emotional as well as intellectual—and so on. For nursing, this devel-
opment allows us to embrace knowledge and knowing in a variety of
ways—those objectively known and those approaches yet to emerge
from the nonphysical sphere.
For example, with an understanding of the different spheres/
quadrants of knowing, we can accommodate nursing diagnosis/tax-
onomy and concrete physical-technical procedural acts on the one
hand with the spiritual and philosophical, subjective, intentional, sym-
bolic, Caring/Caritas Consciousness, “Presencing,” and Being on the
other hand. As Jarrin (2006) noted in an exposition of a unifying the-
ory of nursing, such nursing has a unifying core for understanding
and translating different foci of nursing within the quadrant context.
Thus, nursing is more able to communicate between and among dif-
ferent foci and through the different and diverse lenses nursing and
nurses bring to the academic and professional practice world. This
shift toward integration of the whole, allowing for different concep-
tualizations, unites rather than separates the many diverse levels and
discourses within the field.
It is within this broader and deeper aspect of tending to basic
needs that we realize that nursing is simultaneously touching upon or
mediating all aspects/quadrants and all energetic chakra system lev-
els, either intentionally or unintentionally. Thus, it is important to be
more intentional, aware, and evolved with respect to where we locate
or “situate” (Jarrin 2006) our caring practices with respect to this
Caritas Process of basic human needs. Chapter 17 explores the seven
chakra systems as another overlay of the quadrant model, consistent
with Caring Science and Caritas Nursing.
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c h a p t e r s e v e n t e e n
The Seven Chakras: An Evolving Unitary View of the Basic
Needs Energy System
The ancient archetypal Eastern chakra system of energy anatomy or
power centers of the human energy system comes into play in deep-
ening our understanding of basic needs and how to assist another
with his or her basic needs. This view goes beyond Maslow’s (1968)
Hierarchy of Needs Model and incorporates both physical and non-
physical needs as one integrated energetic system. This ancient
yet evolved energetic chakra system can be seen as an overlay on
the Wilber Integral Quadrant Model. It invites the more advanced
Caritas Consciousness Nurse to move from focusing exclusively on
the dominant right side of the quadrant and prepare for more inten-
tional, conscious caring-healing acts and practices that originate in
the left quadrant but manifest in the right, outer-world quadrant.
An introduction and overview of the chakra system will help clarify
this view.
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t he sev en ch akra s
Figure 20. Autorité Spirituelle et Pourvoir-Aubusson, by Albert Gliezes. Collection,
The Denver Art Museum.
In the chakra energetic body system, there are seven centers of
power, or life force centers, that run through our bodies. However,
within this system of knowledge there is a oneness of biological, psy-
208
t he s ev e n c ha kr a s
chological, emotional, and spiritual needs; they are all the same. For
example, in this energetic body system model, spirituality is an inher-
ent biological need, just as biological needs for food and fluid, elimina-
tion, and ventilation are inherently spiritual (Myss 1996).
Perhaps within this non-dual holographic integration of Wilber
and Myss (Four-Quadrant Model with Seven-Center Energetic Chakra
System), with respect to Caritas Nursing and basic needs we can envi-
sion chakras as what Wilber refers to as “lines” of development and
states of caring that transcend the quadrants, running through them.
Jarrin (2006) uses examples of such lines in nursing as:
• Roach’s Six Cs of Caring (Roach 2002)
• Watson’s Clinical Caritas Processes (Watson 2004a)
• Leininger’s Taxonomy of Caring Constructs (Leininger 1981).
Newman’s (1994) theory of health as expanding consciousness,
Rogers’s (1970) Unitary perspective, Boykin and Schoenhofer’s (2001)
ontological caring stance, and Watson’s (2002a, 2003, 2005, 2006)
transpersonal writings account for nonphysical, nonordinary states in
caring. Thus, different types of caring can include professional (nurs-
ing and non-nursing) as well as nonprofessional health care provid-
ers. Both lines and levels of nursing become types of caring as well
(Jarrin 2006). So, practices and practical programs that focus primar-
ily on body-system/disease frameworks can be seen as adequate tech-
nical practices, but they are incomplete with respect to professional
Caritas knowledge-driven practices. Such limited outer-world, right-
quadrant practice frameworks are incomplete and inadequate with
respect to notions of Caritas Nursing and a more mature disciplinary
Caring Science context.
If action is informed only by the right-sided quadrant objective
field, nursing can be and often is reduced to a task, an end in and of
itself. Likewise, the person/patient is reduced to the physical “case,”
to the moral status of object. As this slippery situation occurs, it allows
acts to be performed that are inconsistent with an ethic of caring that
honors the “face,” the whole person. For example, if another human
being is reduced to the moral status of object, one can begin to justify
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t he sev en ch akra s
doing things to the other as object, something one would never do to
a fully functioning, whole person.
However, if such practices are located within a total-knowledge,
energetic, integral chakra system, those same highly technical, con-
crete tasks (manifest in the outer right-side quadrant/lower chakras)
can be informed/transformed by a left-quadrant evolved conscious-
ness and intentionality of the nurse who is working from the left quad-
rant, with an awareness that the whole is affected. Likewise, even if the
starting point is the right quadrant, the Caritas Nurse is aware that she
or he is affecting the left-quadrant experiences. They are the same.
In a professional, evolved Caring Science/Caritas Process model,
these basic tasks and body-physical acts are highly regarded, respected,
and viewed from a larger lens; they are viewed from the left-side quad-
rant as well as the evolved energetic chakra system. Thus, the task, basic
need, or physical care is not isolated from the whole person, nor is it
isolated from the total disciplinary Caring Science knowledge system.
To explore the chakra energetic system in more depth for the
Caritas Nurse, we seek wisdom traditions and perennial philosophies
across time and cultures. Such ancient knowledge, often located within
the left quadrant model, instructs us on ancient truths associated with
directing our life force and energy source in the outer world.
These chakra energy system understandings and evolution help
us understand how we embody and balance our energies of body and
soul, of thought and action, of physical and mental, for health and
healing. The system of primary energies is both/and, not either/or; it
is both physical and spiritual. It develops and guides us throughout life
toward an evolving consciousness and wholeness of being, transcend-
ing illness and disease. The energetic spiritual-physical chakra system
lines up with the left and right quadrant model. Thus, there is room for
wholeness of the practitioner and his or her evolution toward becom-
ing more human, more caring, more healing and humane while simul-
taneously allowing the profession to locate its actions within a whole
knowledge system for any practice epistemology (Hagedorn personal
communication, 2006).
Our bodies contain an immanent blueprint for healing, in that
humans are energy duplicates of a spiritual power, a life energy force
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t he s ev e n c ha kr a s
connecting us to universal energy, sometimes referred to as the “Divine
power system” of the universe (Myss 1996:64). In other words, for
every physical aspect of the body and its manifestation on the physi-
cal plane, there is a metaphysical overlay of an energetic life force.
This perspective gives an entirely different meaning and purpose to
understanding how to assist with basic human needs; it incorporates a
sacred energetic framework whereby self and others can be helped to
co-create their own health and healing while learning to live life more
fully. Or this framework can help nurses assist others in more fully
mobilizing the energetic life force of self and other through the sacred
act of attending to so-called basic human needs.
According to Myss in her 1996 work (my guide for the perspective
here), “our biological design is also a spiritual design” (1996:64); thus,
energy and spirit come together. It is interesting that this biological-
spirit (energy) connection view of humanity and nursing phenomena
has been advanced by Nightingale (1969) and Martha Rogers (1970)
and explored by others, including Macrae (2001), Newman (1994),
Watson (1999, 2005), and Watson and Smith (2002).
Myss (1996) makes these connections more explicit, however, inte-
grating the spiritual-energetic system with the biological-physical,
including health challenges, physical and emotional suffering, illness,
and diseases. She therefore creates possibilities for understanding that all
human stress corresponds to a spiritual (or metaphysical) crisis at some
level—thus presenting an opportunity for deeper learning and evolving
of one’s consciousness (Newman 1994) toward healing/health.
Finding solutions for assisting self and other with basic needs then
takes on an entirely different meaning, inviting each person to gain
insight regarding his or her own energy system and accessing, redi-
recting, and balancing one’s own spirit/energy/power for reclaiming/
returning to one’s original wholeness-of-being.
Chakra EnErgy Body SyStEm
This revised framework acknowledges the connectedness of each
basic need and the holographic nature of all the needs, in that the
needs of the whole (person) are contained within each part/each
act. The entire caring consciousness embraces each part/each act.
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t he sev en ch akra s
The unity of oneness of mind-
body-spirit is acknowledged.
The physical is overlaid by the
metaphysical, the physical with
the nonphysical-energetic-spiri-
tual dimensions of our human-
ity, the sacred with the profane
or ordinary.
Within this expanded holo-
graphic view, we can acknow-
ledge the reality of basic needs
and a way to think about them
for intellectual purposes, both
as identified separate basic
needs for physical survival—
commonly the focus of nurs-
ing care—and as evolving
spirit-filled needs, also needed
for soul survival of sorts. Thus,
we grasp that each physical
need has a metaphysical overlay. Figure 21. Art by Alex Grey’s Sacred
Moreover, in a Caritas Nursing Mirrors, depicting “transpersonal caring.”
model we acknowledge that www.alexgrey.com.
each physical act carries a spirit-
filled energy. We expand and extend our focus toward how we assist
others in meeting their basic human needs. We shift to considering the
deeper Caritas Consciousness—the sacred acts of ministering/adminis-
tering to others in helping them meet their basic needs, not as parts
but ministering to a whole person, a whole knowledge system that is
unified and spirit-filled.
BiophySiCal nEEdS and
CorrESponding EnErgEtiC Chakra SyStEm
The basic biophysical needs are considered the most primitive, instinc-
tual, biological needs for physical survival of the body physical, with
involuntary organic responses and requirements: food, drink, elimina-
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t he s ev e n c ha kr a s
tion, ventilation, and sexual expression. These basic needs are associ-
ated with the energetic ancient system of chakras, which include the
first through the third chakras.
1. First chakra: base chakra—grounding-connecting with Mother
Earth energy for full embodiment; also considered the “root chakra.”
The first chakra is located at the base of the spine. It is related to
grounding, connectedness with the energy of Mother Earth; the spiri-
tual significance is related to the material world. The ancient arche-
typal “truth” associated with this chakra is the truth of “all is one,” in
that we acknowledge the interconnectedness of all of life and to one
another. We are not separate from each other or from the energy of
the whole. We are all part of the family of humanity. This belief is a
universal spiritual understanding associated with the base chakra as
the foundation for life strength (Myss 1996).
This energetic center encompasses physical body support: the base
of the spine, legs, bones, feet, rectum, and immune system. It is asso-
ciated with one’s ability to be-in-the-world, to be connected with the
earth plane, and to “stand up” for self. This reflects the ability to pro-
vide for life necessities, feeling at home, having a physical family, and
enjoying group safety and security connected with social and familial
order and law (Myss 1996). This energy represents tribal power as an
archetype for group identity, group force, willpower, and group belief
systems. It connects us with familial meanings; it reflects our iden-
tity, associated with a sense of belonging to a group, a culture, a geo-
graphic location (Myss 1996). The energy connection is the founda-
tion of emotional and mental health, stability from within the family
unit, and early social experiences.
The primary fears inherent in this energetic location are fear of sur-
vival, abandonment by the identified group/family, and loss of physi-
cal order. The primary strengths associated with this chakra include
family “identity, bonding, honor code and the support and loyalty that
give one a sense of safety and connection to the physical world” (Myss
1996:164).
The color associated with this first chakra is red.
The Carative Factor/Caritas Process most closely related to this
chakra is number 8: provision for a supportive, protective, and corrective
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t he sev en ch akra s
environment/safe space, healing space whereby physical-nonphysical
aspects are included in basic physical care needs: for example, comfort,
dignity, safety, privacy, and so on, for maximizing healing.
2. Second chakra: pelvic chakra—associated with sexuality, cre-
ativity, and the birthing of new life, whether as ideas or a biological
life force. The second chakra is located in the pelvic area. This energy
point is attuned to biological design for procreation, creativity, sex-
ual union, and relationships: from Eros to Philos to Agape connections
ranging from marriage to friendship to professional bonds and part-
nerships to Agape Love. The sacred dimension operating here is honor-
ing self and other, acting with integrity in all relationships.
This second chakra is considered the “partnership chakra” and is
tied to the power of relationships. Here the energy shifts to discover-
ing relationships that satisfy personal and physical needs (Myss 1996).
The location is the lower abdomen to the navel area, including sexual
organs, large intestine, lower vertebrae, pelvis, hip area, appendix, and
bladder. The area is connected to the need for relationships, sexual-
creative expression, and our need for control over the physical envi-
ronment, including money and other forms of expressivity within our
environment.
The second chakra is activated by fear of losing control, losing
relationships, losing love, being betrayed, and losing power of the
physical body. The primary strengths are related to financial survival,
protecting oneself, and the ability to establish partnerships, personal
property, and decision making (Myss 1996). This is the energetic site of
personal-professional, creative expression, whereby individual talents
and one’s life force are manifest.
The color associated with the second chakra is orange.
Carative Factors/Caritas Processes 6 and 9 are most prominent with
respect to the second chakra system: CF/CP 6: systematic use of cre-
ative problem solving in the caring process, creative use of self and all
ways of knowing to engage in the artistry of caring practices; CF/CP
9: assistance with gratification of basic human needs and expressivity.
3. Third chakra: solar plexus chakra—associated with “gut” feel-
ings, the seat of all emotions, emotional urges, instinctual fight-or-
flight responses; this energy center connects with the “stomach, pan-
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t he s ev e n c ha kr a s
creas, adrenals, upper intestines, gallbladder, liver and the middle
spine, located behind the solar plexus” (Myss 1996:167). According to
Myss, this center is related to our personal power, the magnetic core
of the personality and ego. It is tied to symbolic and energetic pulls
between the external world and internalized self. This is the site where
primary fears are held, “such as rejection, criticism, failing to meet
one’s responsibilities; all fears related to physical appearance, aging,
fears others will discover our secrets” (Myss 1996:168). The primary
strengths from this energy point are “self-esteem, self-respect, and self-
discipline, ambition, the ability to generate action, to handle a crisis,
courage to take risks, ethics, strength of character” (Myss 1996:168).
The color associated with the third chakra is yellow.
Carative Factor/Caritas Process 5 is most strongly associated with
this energetic field: promotion and acceptance of the expression of
positive and negative feelings.
These three lower chakras are associated with basic biophysi-
cal needs—elimination, food and fluid, ventilation, sexuality. These
basic needs are associated with sources of energy from Mother Earth,
energy from earth itself as the ground of our Being.
These needs incorporate intimacy, sensuality, body movement,
opening the body energetically for freedom of movement, ventila-
tion, and breath, thus also affecting the ventilation need. The solar
plexus is the center for the expression of feelings, emotions, fear, anxi-
ety, resentment—stored emotions with a need for expression, the so-
called gut emotions.
I resist categorizing the basic needs into lower biophysical and
higher-order needs; however, for study and learning purposes, some-
times one must explore the foundational parts even while holding the
whole/hologram as background. All biophysical human needs can be
framed holographically as those needs that are foreground and basic
for human survival and that are instinctual and organic; however,
every basic biophysical need has a metaphysical overlay, reflected by
the chakra system.
Regarding these identified biophysical needs, we share them with
animals as basic survival instincts. These basic needs are primal, pri-
mordial, instinctual, often involuntary, and essential to our humanity.
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t he sev en ch akra s
Within a professional Caritas Consciousness, there is an honoring of the
embodiment of spirit within each need. Every individual need affects
and is part of the whole being of the person, and the person’s whole
being can be reflected in any one need. While there may be a present-
ing need, the whole is always present as background to the need pre-
senting itself in a given moment.
For our purposes here, the foreground can be the need for food
and fluid, elimination, ventilation, activity, and sexuality. These are the
most basic survival needs and those closely aligned with the first three
chakras.
These basic survival needs are primarily associated with the first
three chakras. But once we move to the fourth chakra, we are evolving
toward deeper dimensions of our humanity and our connection with
higher spirit-filled awareness, beyond the physical realm.
As we move beyond these most basic survival-instinctual–level
needs, we can identify other human needs—also basic but at a different
level, beyond physical survival and for survival of the spiritual self, in a
way. Other needs beyond the basic survival-instinctual needs are those
always present in the human, those influenced by cognition, reflec-
tion, emotions, desire, evolving consciousness, self-awareness, will,
and so on. Examples include the need for self-love, self-esteem, self-
control, self-knowledge, self-caring, self-fulfillment, self-awareness,
self-acceptance, self-growth, autonomy, relationships, love, connec-
tions, and so forth. The evolved human then moves toward the fourth-
level archetypal awareness of the energetic life force source.
human Evolution—highEr-ConSCiouSnESS EnErgy SyStEmS
4. Fourth chakra: heart chakra—this energetic point is connected with
love, compassion; moving from ego-centered, physical-emotive, fear-
motivated human to heart-centered human; open to that which con-
nects one with the greater source of life. Here we are moving from the
dominant physical plane to a higher/deeper spiritual awakening of the
senses and sensibilities. The heart chakra includes the heart and circu-
latory system, lungs, shoulders and arms, ribs and breasts, diaphragm,
and thymus glands (Myss 1996). It is linked to feelings of forgiveness,
hope, and trust as well as love, commitment, and compassion. A closed
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t he s ev e n c ha kr a s
heart chakra walls up hatred, resentment, bitterness, grief, anger, self-
centeredness, and loneliness (Myss 1996). A heart-centered person
moves from a cognitive, rational, head-ego focus toward openness to
learning, to seeing other ways of Being-in-the-world. One becomes a
person whose heart can hold forgiveness; one develops an open heart
filled with loving-kindness, equanimity, and mindfulness; a heart open
to the paradox of the ability to hold joy and pain, side by side. As the
evolved human opens the heart, he or she can discover wisdom seek-
ing/insight/new sight/new ways of seeing and understanding.
I have heard it said that when one opens the heart chakra, one is
opening up all other chakra energy points to allow an energetic flow
throughout the whole body. The heart chakra is the center for love,
compassion, and companionship and opens access to that which is
greater than the self on the physical plane of existence; this opens one
to connect with the infinite field of universal Love. This chakra teaches
us how to act out of love and compassion and caring, recognizing that
the most powerful energy we have is love (Myss 1996).
Myss says that more than any other chakra, the “[f]ourth repre-
sents our capacity to ‘let go and let God.’ With its energy we accept
our personal emotional challenges as extensions of a Divine plan,
which has as its intent our conscious evolution. By releasing our emo-
tional pain, by letting go of our need to know why things have hap-
pened as they have, we reach a state of tranquility. In order to achieve
that inner peace, however, we have to embrace the healing energy of
forgiveness, and release our lesser need for human self-determined jus-
tice” (Myss 1996:197–198).
The primary fears associated with the heart chakra include fear of
loneliness, commitment, and “following one’s heart”; the fear of an
inability to protect oneself emotionally; fear of emotional weakness,
betrayal. The loss of heart-centered energy can give rise to jealousy,
bitterness, anger, hatred, and an inability to forgive others and self
(Myss 1996:198). The primary strengths of this chakra include Love,
forgiveness, compassion, dedication, inspiration, hope, trust, and the
ability to heal oneself and others. Love in its purest form—uncondi-
tional Love—is the substance of the Divine. Our hearts are designed
to express beauty, compassion, forgiveness, joy, and love. Love is the
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t he sev en ch akra s
fuel of our physical and spiritual bodies. Each lesson in life, at some
level, is a lesson in some respect about learning more about love (Myss
1996:198–199).
The color associated with the fourth chakra is green.
This fourth heart chakra is highly associated with Carative Factor/
Caritas Process 1: humanistic-altruistic values; practice of loving-kind-
ness and equanimity toward self and other. As the Caritas Nurse evolves
more fully within the Caritas Model, she or he is cultivating this energy
point; this chakra makes the greatest contribution toward caring-heal-
ing practices. The Caritas Nurse is open to a heart-centered conscious-
ness evolution, moving beyond the strictly intellectual, technical, ego-
head-centered nurse.
Thus, there is a difference between ordinary nursing and Caritas
Nursing. The difference lies in the evolution of heart-centered con-
sciousness and working from this evolved awareness, including the
fourth chakra and above, to address any lower chakra issues. The first
Caritas Process of loving-kindness and equanimity contributes to the
evolution of Caritas Nursing practices. Cultivation of this energetic
source is foundational for caring-healing work in the world. When the
heart chakra is open, we connect with source.
5. Fifth chakra: “throat chakra”—giving voice to one’s life force
expression in the world. This center is related to expression through
the voice to convey one’s heartfelt intentions, bringing voice to action,
seeing and knowing through mind and heart and evolving conscious-
ness. The organs associated with this energy anatomy include throat,
thyroid, trachea, neck vertebrae, mouth, teeth, gums, esophagus,
parathyroid, and hypothalamus (Myss 1996:98). According to Myss,
the symbolic challenge of this chakra is to progress through the matu-
ration of will, from the perception that everyone and everything has
authority over you to the perception that you have authority over
you and making onward progress in realizing/awakening to the fact
that true authority comes from aligning yourself with the higher will
of God/Godhead. This includes a spiritual surrender of ego control
to that which is greater. The primary fears are related to having no
authority or power of choice within our own lives and our personal-
professional relationships. Then, fearing that we have no authority
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t he s ev e n c ha kr a s
within ourselves results in being out of control with money, diet, food,
drugs, and similar issues; there is fear of another person’s control over
our well-being. Finally, we fear the will of God, the greatest struggle
for releasing control to a higher source (Myss 1996:220).
The primary strengths of this energetic source are faith, self-
knowledge, personal authority, and the capacity to make decisions,
to stand in place with one’s true self and give authentic expression
to one’s being-in-the-world. The strength comes from deeply know-
ing that we have the capacity to keep our word to ourselves and to
another/others.
The color associated with the fifth chakra is blue.
The Carative Factors/Caritas Processes associated with the throat
chakra are numbers 2: faith-hope-helping others sustain a deep belief
system; and 4: development of an authentic helping-trusting-caring
relationship.
6. Sixth chakra: “the third eye”—evolving consciousness involves
our mental and reasoning abilities and reflective skills in evaluating
our beliefs and attitudes. This chakra resonates with the energies of
our psyches, our consciousness forces. The Eastern literature refers
to this chakra as the “ ‘third eye’ or spiritual center in which mind and
psyche cultivate intuitive sight and wisdom” (Myss 1996:237). Thus, it
can also be thought of as the chakra of wisdom, higher consciousness,
seeing beyond the ego, and developing insight.
The location of the sixth chakra is the center of the forehead. The
challenges here are opening the mind, cultivating an impersonal mind,
recognizing “false truths” (Myss 1996:237), becoming self-directed,
discriminating between thoughts motivated by Love and strength and
those motivated by fear and illusion and control. Ultimately, I consider
this chakra to represent evolving consciousness and movement toward
a higher/deeper level of awakening to one’s highest consciousness,
which is Love (Watson 2005). The energy connection with the physi-
cal body includes the brain, neurological system, pituitary and pineal
glands, as well as the eyes, ears, and nose (Myss 1996:237).
The lessons along the way in relation to evolving consciousness
include our ability to become a witness to our own beliefs and states
of mind, leading to wisdom, serenity, and inner peace. This encom-
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t he sev en ch akra s
passes the ability to be still in the midst of threats and chaos, to discern
power struggles of illusion versus insight within a greater picture of
the divine order of the universe and our connection to it.
The primary fears embodied in this area include an unwillingness
to look within, fear of inner exploration, and fear of one’s shadow
side and its attributes. The challenges include being stuck in predeter-
mined mind-sets and beliefs, fear of releasing illusions of the external
world, and an unwillingness to explore one’s shadow side with equa-
nimity and forgiveness. The primary strengths include cultivation of
deeper self-awareness, insights, wisdom, creativity; higher conscious-
ness for intuitive reasoning; and emotional intelligence: in summary,
becoming a more evolved human (Myss 1996).
The color associated with the sixth chakra is amethyst violet.
The Carative Factors/Caritas Processes associated with the sixth
“third eye” chakra include numbers 1: humanistic-altruistic value sys-
tem/practice of loving-kindness and equanimity; and 10: allowing for
existential-phenomenological-spiritual dimensions in one’s own life,
evolution; opening and attending to “mystery,” deeper truths behind
illusions—“allowing for a miracle.”*
7. Seventh chakra: “crown chakra”—spiritual transcendent connec-
tor. This energy source is our connection to our spiritual nature, our
capacity to bring Spirit into our lives and world. It invites grace, mercy,
Love, and surrender to enter our lives, allowing for an intimate rela-
tionship with the Divine. This chakra opens us to our quiet, inner soul
source for alignment with the universal energy of Cosmic Love (Watson
2005), whereby our inner awareness, awakening, and practices of medi-
tation, prayer, and spiritual sacraments allow us to transcend our ego-
physical self. The location for this chakra is the top of the head.
This chakra is considered the entry point for the human life force,
which pours endlessly into the human energy system from the greater
universe, from the God/Godhead (Myss 1996:265). According to Myss
(1996), as depicted in the artwork of Hildegard of Bingen (see Figure
19, Chapter 15), “this life force from the universe nourishes the body,
the mind, and the spirit. It distributes itself throughout the physical
* From interpretation by Resurrection Health in Chicago.
220
t he s ev e n c ha kr a s
body and the lower six chakras, connecting the entire physical body to
the seventh chakra. The energy of the seventh chakra influences all of
the other major body systems: the central nervous system, the muscu-
lar system, and the skin” (Myss 1996:265).
The seventh chakra contains the energy that inspires and gener-
ates devotion, prophetic thoughts, transcendent ideas, and mystical
connections. It is reported that this chakra contains the purest form of
the energy of grace and Love; it safeguards our capacity for insights,
vision, and intuition beyond ordinary consciousness. It is the mystical
realm (Myss 1996:266). It can also be considered as closely aligned with
the basic human need for self-actualization, but it goes beyond that to
the realm of the Divine, the mystical, opening to infinity.
According to Myss, the primary fears associated with the seventh
chakra relate to spiritual issues of the “dark side of the soul”: fears of
abandonment, loss of identity, and loss of our connection with life
and those around us. The primary strengths of this chakra include
faith in the presence of the Divine, having faith-hope in that which is
greater than self, a divine ordering in one’s life and experiences, a pro-
found trust that order is unfolding in the midst of chaos, confusion,
crises, fears, and so on. This trust, faith, and strength of spirit help one
overcome ordinary human fears, to seek devotion, silence, prayer, and
patience to cope with unknowns.
The color associated with the seventh chakra is white.
The seventh chakra is the one that allows nurses and others to be
“open to a miracle” for self and other. Thus, the Carative Factors/Caritas
Processes most closely associated with this chakra are numbers 1: prac-
tice of loving-kindness and equanimity; and 10: opening to spiritual-
mysterious and existential dimensions of one’s life and death: “allow-
ing for a miracle.”
Once nurses and other health and healing practitioners connect
with their own energy source and attend to evolving their conscious-
ness to a higher/deeper realm, they open up sources of energy for
different aspects of their life force and Being-in-the-world while simul-
taneously uniting with an infinite source of energy, allowing them to
transcend any situation. They are then awakened to a greater sense of
self, of community, communion, spiritual evolution, and so on.
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